Provider Demographics
NPI:1114311107
Name:YAEGER, STACIE MARIE (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:MARIE
Last Name:YAEGER
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 HILLTOP RD
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:NJ
Mailing Address - Zip Code:08759-1349
Mailing Address - Country:US
Mailing Address - Phone:732-849-4400
Mailing Address - Fax:
Practice Address - Street 1:3000 HILLTOP RD
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:NJ
Practice Address - Zip Code:08759-1349
Practice Address - Country:US
Practice Address - Phone:732-849-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00670900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist